| Indian Health Center | |
|
2030 Forest Ave Ste 110 San Jose CA 95128-4833 | |
| (408) 445-3400 | |
| Not Available |
| Full Name | Indian Health Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2030 Forest Ave Ste 110, San Jose, California |
| Authorized Official Name and Position | Aldon Wayne Scott (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 4084453400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indian Health Center 1333 Meridian Ave San Jose CA 95125-5212 Ph: (408) 445-3400 | Indian Health Center 2030 Forest Ave Ste 110 San Jose CA 95128-4833 Ph: (408) 445-3400 |
| NPI Number | 1326425265 |
|---|---|
| Provider Enumeration Date | 04/29/2015 |
| Last Update Date | 03/22/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326425265 | NPI | - | NPPES |
| FHC11833F | Other | CA | STATE PROGRAMS |
| G01133-01 | Other | CA | DELTA DENTAL |
| 55-1120 | Other | CA | MEDICARE PALMETTO |
| FHC11833F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 70000482 (California) | Primary |
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